Attitudes about Injury among High School Students

Just my luck: How children's causal attributions contribute to injury prevention

PURPOSE

Traumatic injury in children, particularly adolescents, is both frequently and costly. In this study, we directly examined children's causal attributions for the recent traumas and asked them to propose prevention strategies of their own. We predict that children who attribute their injuries to their own actions, rather than an external force such as luck, will be more likely to develop strategies to avoid trauma in the future.

METHODS

All children aged 10 -18 years who presented to a Level 1 pediatric trauma center at an urban children's hospital over a ten-month period were identified and presented with a series of structured interview questions. They were asked to describe the cause of their injuries, whether they believed them to be avoidable, and what strategies, if any, they thought might have prevented their trauma.

RESULTS

46 children with an average age of 13.4 years were surveyed and the responses of 44 children were analyzed. Most injuries resulted from sports (24) or motor vehicle accidents (14). The remaining injuries were due to burns (4) and falls (2). Twelve (27%) children believed that their own behavior was to blame for their injuries. 32 children ascribed their injuries to circumstances outside of their control with the majority (30, 94%) viewing themselves as "unlucky." Children who accepted fault for injury and children who thought their accident was avoidable were more likely to be able to formulate a strategy for preventing future injury. Children who thought their accident was avoidable were also more likely to accept fault for it.

CONCLUSION

Children surveyed denied their own culpability and preferred to attribute their injuries to bad luck. Moreover, children who believed themselves to be simply unlucky were less able than others to propose strategies that might prevent further injury.

The involvement of trauma survivors in hospital-based injury prevention, violence intervention and peer support programs: A scoping review

BACKGROUND

Despite decades-long involvement of trauma survivors in hospital-based program delivery, their roles and impact on trauma care have not been previously described. We aimed to characterize the literature on trauma survivor involvement in hospital-based injury prevention, violence intervention and peer support programs to map what is currently known and identify future research opportunities.

METHODS

A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. Articles were identified through electronic databases and gray literature. Included articles described hospital-based injury prevention programs, violence intervention programs and peer support programs that involved trauma survivors leveraging their injury experiences to counsel others. Studies were screened and data were abstracted in duplicate. Data were synthesized generally and by program type.

RESULTS

Thirty-six published articles and four program reports were included. Peer support programs were described in 21 articles, mainly involving trauma survivors as mentors or peer supporters. Peer support programs' most commonly reported outcome was participant satisfaction (n = 6), followed by participant self-efficacy (n = 5), depression (n = 4), and community integration (n = 3). Eleven injury prevention studies were included, all involving trauma survivors as speakers in youth targeted programs. Injury prevention studies commonly reported outcomes of participants' risk behaviors and awareness (n = 9). Violence intervention programs were included in four articles involving trauma survivors as intervention counsellors. Recidivism rate was the most commonly reported outcome (n = 3). Variability exists across and within program types when reporting on involved trauma survivors' gender, age, selection and training, duration of involvement and number of survivors involved. Outcomes related to trauma survivors' own experiences and the impacts to them of program involvement were under-studied.

CONCLUSIONS

Significant opportunity exists to fill current knowledge gaps in trauma survivors' involvement in trauma program delivery. There is a need to describe more fully who involved trauma survivors are to inform the development of effective future interventions.

Invincibility threatens vaccination intentions during a pandemic

Some people feel they are invincible to the novel coronavirus SARS-CoV-2 (COVID-19). They believe that being infected with COVID-19 would not be a serious threat to their health. While these people may or may not be correct in their personal risk assessment, we find that such perceived invincibility may undermine community efforts to achieve herd immunity. Multi-level analysis of survey respondents across 51 countries finds that perceived invincibility from COVID-19 is negatively associated with believing there is a need to prevent the spread of COVID-19 in one's community (n = 218,956) and one's willingness to inoculate against the disease (n = 71,148). These effects are most pronounced among individuals from countries lower in cultural collectivism (e.g., USA, UK, Canada) and highlight the need to consider the interplay of individual and cultural factors in our efforts to understand, predict, and promote preventative health behavior during a pandemic.

School-based education programmes for the prevention of unintentional injuries in children and young people

BACKGROUND

Unintentional injuries are the leading cause of death in children aged four to 18 years and are a major cause of ill health. The school setting offers the opportunity to deliver preventive interventions to a large number of children and has been used to address a range of public health problems. However, the effectiveness of the school setting for the prevention of different injury mechanisms in school-aged children is not well understood.

OBJECTIVES

To assess the effects of school-based educational programmes for the prevention of injuries in children and evaluate their impact on improving children's safety skills, behaviour and practices, and knowledge, and assess their cost-effectiveness.

SEARCH METHODS

We ran the most recent searches up to 16 September 2016 for the following electronic databases: Cochrane Injuries Group Specialised Register; Cochrane Central Register of Controlled Trials; Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations; Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R); Embase and Embase Classic (Ovid); ISI Web of Science: Science Citation Index Expanded; ISI Web of Science Conference Proceedings Citation Index-Science; ISI Web of Science: Social Sciences Citation Index; ISI Web of Science: Conference Proceedings Citation Index - Social Sciences & Humanities; and the 14 October 2016 for the following electronic databases: Health Economics Evaluations Database (HEED); Health Technology Assessment Database (HTA); CINAHL Plus (EBSCO); ZETOC; LILACS; PsycINFO; ERIC; Dissertation Abstracts Online; IBSS; BEI; ASSIA; CSA Sociological Abstracts; Injury Prevention Web; SafetyLit; EconLit (US); PAIS; UK Clinical Research Network Study Portfolio; Open Grey; Index to Theses in the UK and Ireland; Bibliomap and TRoPHI.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), non-randomised controlled trials (non-RCTs), and controlled before-and-after (CBA) studies that evaluated school-based educational programmes aimed at preventing a range of injury mechanisms. The primary outcome was self-reported or medically attended unintentional (or unspecified intent) injuries and secondary outcomes were observed safety skills, observed behaviour, self-reported behaviour and safety practices, safety knowledge, and health economic outcomes. The control groups received no intervention, a delayed injury-prevention intervention or alternative school-based curricular activities. We included studies that aimed interventions at primary or secondary prevention of injuries from more than one injury mechanism and were delivered, in part or in full, in schools catering for children aged four to 18 years.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors identified relevant trials from title and abstracts of studies identified in searches and two review authors extracted data from the included studies and assessed risk of bias. We grouped different types of interventions according to the outcome assessed and the injury mechanism targeted. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies.

MAIN RESULTS

The review included 27 studies reported in 30 articles. The studies had 73,557 participants with 12 studies from the US; four from China; two from each of Australia, Canada, the Netherlands and the UK; and one from each of Israel, Greece and Brazil. Thirteen studies were RCTs, six were non-RCTs and eight were CBAs. Of the included studies, 18 provided some element of the intervention in children aged four to 11 years, 17 studies included children aged 11 to 14 years and nine studies included children aged 14 to 18 years.The overall quality of the results was poor, with the all studies assessed as being at high or unclear risks of bias across multiple domains, and varied interventions and data collection methods employed. Interventions comprised information-giving, peer education or were multi-component.Seven studies reported the primary outcome of injury occurrence and only three of these were similar enough to combine in a meta-analysis, with a pooled incidence rate ratio of 0.73 (95% confidence interval (CI) 0.49 to 1.08; 2073 children) and substantial statistical heterogeneity (I² = 63%). However, this body of evidence was low certainty, due to concerns over this heterogeneity (inconsistency) and imprecision. This heterogeneity may be explained by the non-RCT study design of one of the studies, as a sensitivity analysis with this study removed found stronger evidence of an effect and no heterogeneity (I² = 0%).Two studies report an improvement in safety skills in the intervention group. Likewise, the four studies measuring observed safety behaviour reported an improvement in the intervention group relative to the control. Thirteen out of 19 studies describing self-reported behaviour and safety practices showed improvements, and of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least one question domain in the intervention compared to the control group. However, we were unable to pool data for our secondary outcomes, so our conclusions were limited, as they were drawn from highly diverse single studies and the body of evidence was low (safety skills) or very low (behaviour, safety knowledge) certainty. Only one study reported intervention costs but did not undertake a full economic evaluation (very low certainty evidence).

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether school-based educational programmes can prevent unintentional injuries. More high-quality studies are needed to evaluate the impact of educational programmes on injury occurrence. There is some weak evidence that such programmes improve safety skills, behaviour/practices and knowledge, although the evidence was of low or very low quality certainty. We found insufficient economic studies to assess cost-effectiveness.

Best Interest of the Child and Parental Alienation: A Survey of State Statutes

State statutes regarding the best interests of the child (BIC) in deciding disputed custody were reviewed and independently coded with respect to three issues (i) the child's preference and any limits (ii) parental alienation and (iii) psychological maltreatment. Results revealed that many states allowed for the child's preferences to be considered and none qualified that preference when undue influence has occurred; parental alienation as a term was not found in any state statutes but 70% of the states included at least one BIC factor relevant to its core construct of the parent supporting the child's relationship to the other parent; and many states included a history of domestic violence or child abuse but only three states explicitly mentioned psychological maltreatment. These findings highlight yet another way in which the BICS factors lack specificity in ways that could negatively impact children caught in their parents' conflict.

From focus groups to production of a distracted driving video: Using teen input to drive injury prevention programming

BACKGROUND

The Impact program is an adolescent, injury prevention program with both school- and hospital-based components aimed at decreasing high-risk behaviors and preventing injury. The objective of this study was to obtain student input on the school-based component of Impact, as part of the program evaluation and redesign process, to ensure that the program content and format were optimal and relevant, addressing injury-related issues important for youth in our region.

METHODS

Secondary schools were selected in various geographic regions with students varying in language, religion, and socioeconomic status. A mixed-methods questionnaire was developed and pretested on program content, format, relevance, quality, and effectiveness. Attitude and opinion questions on issues facing teens today were ranked on a 7-point Likert scale. Open-ended, qualitative questions were included in the focus groups, with responses themed.

RESULTS

There were 167 respondents in the nine geographically, socioeconomically, and culturally diverse focus groups with a mean age of 16 years, 52% were male, and 69% were in Grade 11. Ninety-three percent of respondents rated the content of Impact as comprehensive (median, 6 of 7, with 7 being very comprehensive), and 29% rated the format a 5 of 7. Impact was rated relevant (89%), addressing issues for teens (median, 6 of 7). Issues suggested to highlight included texting and driving, drugs, partying, self-harm, and abusive relationships. Texting while driving was perceived as a significantly more common (81%) injury issue for adolescents compared with other driving risk factors (p < 0.001), with one student commenting, "If you don't (text and drive), you either don't have a phone or don't have a driver's license."

CONCLUSION

Injury prevention programs must be continually evaluated to ensure they are relevant, addressing issues important for youth, and presented in a format that resonates with the audience. Student focus groups identified motor vehicle collisions and texting as important issues as well as a desire for teens to hear personal stories with a visual element. This provided the information needed to develop the next logical direction for our program, the production of a distracted driving video ("Distracted Driving: Josh's Story," http://youtu.be/BFPke9gBybc) to be incorporated into school presentations.

LEVEL OF EVIDENCE

Epidemiologic/prognostic study, level III.

Invincibility fable: tool development to measure invincibility

Invincibility is a phase of social-cognitive development of the adolescent and has been associated with risk behavior involvement.

OBJECTIVE

To determine psychometric properties of the Adolescent Invincibility Tool (AIT).

METHODS

Reliability was assessed and validity was examined using principal components analysis.

RESULTS

Internal consistency was demonstrated with a Cronbach's alpha of .88; factor analysis led to the confirmation of subscales. Criterion validity was validated with similar and opposing measures of invincibility.

DISCUSSION

Initial testing suggests that the AIT is a valid and reliable tool for screening invincibility. Further testing is recommended to determine relevance for other populations of youth.

Impact of an injury prevention program on teenagers' knowledge and attitudes: results of the Pense Bem-Caxias do Sul Project

OBJECT

Trauma is the leading cause of mortality and morbidity in children, young people, and working-age adults. Because of the high incidence of intentional and unintentional injuries in young people, it is necessary to implement injury-prevention programs and measure the efficacy of these initiatives. The authors evaluated the effectiveness of an injury-prevention program in high school students in a city in southern Brazil.

METHODS

In a randomized controlled study, 1049 high school students were divided into a control group and intervention group. The study was conducted in the following 3 stages: a questionnaire was applied 1 week before the educational intervention (P0), shortly after the intervention (P1), and 5 months later (P3). In the control group, a questionnaire based on the Pense Bem Project was applied at the 3 time stages, without any intervention between the stages.

RESULTS

The postintervention analysis evidenced a slight change in knowledge about unintentional spinal cord and brain injuries. Regarding attitudes, the only significant improvement after the intervention lecture was in the use of helmets, which remained high 5 months later. A substantial number of students only partially agreed with using safety behaviors. The only significant postintervention change was the major agreement to check swimming pool depth before entering the water (P0 89% and P1 97.8%, p < 0.001; P2 92.8%, p = 0.005).

CONCLUSIONS

An educational intervention based on a single lecture improved students' knowledge of traumatic brain and spinal cord injuries, but this type of intervention did not modify most attitudes toward injury prevention. Clinical trial registration no.: U1111-1121-0192.

How do adolescents view health? Implications for state health policy

OBJECTIVES

Policy-makers rarely consult adolescents during development of health policies. However, perspectives of adolescents on health can inform public health policies and programs. As part of the development of an Indiana state plan for adolescent health, we used qualitative methods to describe adolescents' "emic" views of health, and discuss implications for a state health policy for youth.

PATIENTS AND METHODS

We conducted eight adolescent focus groups in geographically and culturally diverse regions of Indiana. Each group was audio-recorded, transcribed, and analyzed using qualitative methods.

RESULTS

Participants described health as a shared responsibility between adolescents and adults in their lives. They identified a key role for supportive adults in initiating and maintaining health behaviors. Physical, financial, and informational environments could support or hinder healthy behaviors and outcomes. Although adolescents' descriptions of physical health and risk behaviors were similar to adult formulations, they described mental health as "stress and fatigue," an interaction between the adolescent and their environment, rather than depression and anxiety which are considered to be individual pathologies. Respect for decision-making capacity, seeking adolescent input, and providing harm reduction messages were identified as particularly important.

CONCLUSIONS

Adolescent's perception of health can inform policies and programs, and should be sought before the development of health policies.

The application of mixed methods designs to trauma research

Despite the use of quantitative and qualitative data in trauma research and therapy, mixed methods studies in this field have not been analyzed to help researchers designing investigations. This discussion begins by reviewing four core characteristics of mixed methods research in the social and human sciences. Combining these characteristics, the authors focus on four select mixed methods designs that are applicable in trauma research. These designs are defined and their essential elements noted. Applying these designs to trauma research, a search was conducted to locate mixed methods trauma studies. From this search, one sample study was selected, and its characteristics of mixed methods procedures noted. Finally, drawing on other mixed methods designs available, several follow-up mixed methods studies were described for this sample study, enabling trauma researchers to view design options for applying mixed methods research in trauma investigations.

A fate worse than death? Long-term outcome of trauma patients admitted to the surgical intensive care unit

INTRODUCTION

Trauma centers successfully save lives of severely injured patients who would have formerly died. However, survivors often have multiple complications and morbidities associated with prolonged intensive care unit (ICU) stays. Because the reintegration of patients into the society to lead an active and a productive life is the ultimate goal of trauma center care, we questioned whether our "success" may condemn these patients to a fate worse than death?

METHODS

Charts on all patients > or =18 years with ICU stay > or =10 days, discharged alive between June 1, 2002, and May 31, 2005, were reviewed. Patients with complete spinal cord injuries were excluded. Demographics, Injury Severity Score (ISS), presence of severe traumatic brain injury (TBI; Head Abbreviated Injury Scale [AIS] score = 4 or 5), presence of extremity fractures, need for operative procedures, ventilator days, complications, and discharge disposition were collected. Glasgow Outcome Scale score was calculated on discharge. Patients were contacted by phone to determine general health, work status, and using this data, Glasgow Outcome Scale score and a modified Functional Independence Measure (FIM) score were calculated.

RESULTS

Two hundred and forty-one patients met inclusion criteria. Thirty-three patients died postdischarge from the hospital and 39 were known to be alive from the electronic medical records but were unable to be contacted. Sixty-nine patients could not be tracked down and were ultimately considered as lost to follow-up. The remaining 100 patients who were successfully contacted participated in the study. Eighty-one percent were men with a mean age of 42 years, mean and median ISS of 28. Severe TBI was present in 50 (50%) patients. Mean and median follow-up was 3.3 years from discharge. At the time of follow-up, 92 (92%) patients were living at home, 5 in nursing homes, and 3 in assisted living, a shelter, or halfway house. FIM scores ranged from 6 to 12 with 55% reached a maximal FIM score of 12. One quarter of patients had FIM scores < or =10 and 10% had locomotion scores of < or =2 (very dependent). Seventy percent considered themselves to be less active. Seventy-six patients were either working or in full-time school before their trauma. Of the 24 patients not working preinjury, 12 were > or =55 years of age. At the time of follow-up, 37 patients (49%) were back to work or school. Severe TBI patients (57%, 21 of 37) were less likely to return to work when compared with 38% (12 of 38; p = 0.03) without severe TBI. There was no relationship with age, ISS, presence of any TBI, head AIS, presence of any extremity fracture, extremity AIS, or ventilator days in patients who did or did not return to work.

CONCLUSIONS

These data demonstrate that ICU survivors >3 years after severe injury have significant impairments including inability to return to work or regain previous levels of activity and that the goal of reintegrating patients back into the society is not being met. Further studies better defining the limitations and barriers to improved quality of life are necessary. Survival, although important, is no longer a sufficient outcome to measure trauma center success.